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Nurse Practitioners Say Expanded Scope of Practice Key for COVID-19

 - Relaxed scope of practice restrictions and models enabling expanded telehealth use have been instrumental in helping nurse practitioners meet patient access to care needs during the COVID-19 pandemic, according to a new survey from the American Association of Nurse Practitioners.

The outbreak of the novel coronavirus put a lot of pressure on the healthcare industry, namely in ensuring every patient could access the care she needed. For those who got sick with the virus, it became a question of whether that patient would be able to receive timely treatment in the acute care setting.

And for the chronically ill, they and their providers had to adapt to new ways of managing care remotely.

Expanded scope of practice and use of telehealth helped meet those needs, respectively, the national survey of NPs practicing during COVID-19 showed.

That said, access to viral testing is still a big pitfall.

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By and large, respondents said testing is the biggest barrier to combatting COVID-19 community spread. Thirty-six percent of nurse practitioners said their patients had been turned away from testing sites because they do not meet testing criteria.

Fifty-three percent reported that testing is available to all patients in their community, while 46 percent said patients must meet certain testing criteria, like displaying symptoms or coming in contact with a known COVID-19 patient.

And even when a patient can receive a test, there are still pitfalls, NPs reported. Seventy-eight percent of respondents said they saw significant delays in getting test results. Test results can take between seven and 10 business days to return, at minimum, and at their worst up to 20 days to return, the survey revealed.

But as much as testing is throwing a wrench in capping COVID-19 spread, NPs said telehealth has been a boon. More specifically, the federal and state policies that supported better telehealth reimbursement made it possible for organizations to continue to treat their patients remotely.

Introduction of new reimbursement models, like those that reimbursed for telehealth, helped NPs fulfill patient access to care needs. Seventy-six percent of NP respondents agreed telehealth reimbursement has been instrumental during the coronavirus pandemic, while 68 percent said the expansion of services covered was important.

READ MORE: AANP: Nurse Practitioners Essential for Coronavirus Care Access


Sixty-two percent said the same about increased reimbursement rates, the ranked-choice question revealed.

More than half of NPs said waivers relaxing scope of practice barriers were helpful in meeting patient needs during the pandemic, the report continued.

Moving forward, 84 percent of NPs said better support for medical providers and facility support staff will be essential for combatting the virus. This kind of support is what helps providers meet the access needs of their patients, Hebert said.

“This survey demonstrates the significant progress NPs are making in combatting COVID-19 in communities nationwide and treating patients in every clinical setting,” explained David Hebert, JD, Chief Executive Officer of AANP. “As a nation, we must work together to address barriers and increase access to patient care, from overcoming delays in COVID-19 test results to eliminating practice restrictions on NPs.”

This includes funding a supply chain that gives NPs and other providers the tools to meet patient needs, especially when such a high volume seeks COVID-19 care and testing.

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“As providers working at the forefront of this pandemic, we urge our policymakers and health care systems to work together to continue strengthening access to viral testing and bolstering the supply chain to shorten wait times for test results — which are vital to limiting outbreaks and achieving better patient outcomes,” said AANP President Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP, FNAP, FAANP.

Notably, this also includes extending state policies that relax scope of practice laws for nurse practitioners.

“We call on policy makers at the federal and state level to respond to the needs of providers and patients as the pandemic continues. We urge policymakers to prioritize access to care for all patients by enacting legislation that enables NPs to practice to the top of their education and clinical training,” Hebert added.

“The pandemic has illuminated longstanding shortcomings in our nation’s health care system. Waivers and adjustments have addressed some of those challenges and have enabled us to effectively provide care during this time. However, it is essential that permanent changes to laws are made to ready our nation for the further delivery of health care to patients and to meet the health care challenges that exist beyond the pandemic.”

Some states are quickly moving in that direction, much to the chagrin of others in the healthcare industry. In Georgia, Governor Brian Kemp recently signed a bill that will expand scope of practice laws for advanced practice registered nurses, which includes NPs. Specifically, SB 321 will allow APRNs to order medical imaging on their own.

Before Kemp signed the bill, it faced considerable lobbying from state and national medical associations. Prominently, the American Medical Association penned a letter to Kemp stating the legislation would endanger patients. Allowing APRNs to order medical imaging may increase the use of that test and expose patients to radiation, AMA wrote. The organization also reiterated that physicians should be the sole leaders of the patient care team.

“The AMA is concerned such expansion will increase health care costs and threatens the health and safety of patients in Georgia,” the groups wrote in a letter to Georgia Governor Brian Kemp, who is the sole policymaker who could stop this already-passed bill from coming into law. “For these reasons we strongly encourage you to veto S.B. 321.”

Kemp signed the bill on August 16.